The Relationship between Parenting Stress Components and Childhood Anxiety in Children with Attention-Deficit/Hyperactivity Disorder: The Mediating Role of Symptom Severity

Abstract

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is frequently comorbid with anxiety disorders; however, the role of the familial environment in this comorbidity remains under-explored. This study aims to investigate a mediation model in which components of parenting stress predict anxiety in children with ADHD, mediated by the severity of ADHD symptoms.

Methods: This descriptive-correlational study employed Structural Equation Modeling (SEM). The statistical population included mothers of children aged 6–12 diagnosed with ADHD who referred to governmental comprehensive health centers and private child psychology clinics in Karaj, Iran, during 2023–2024. A convenience sample of 210 mothers was recruited, and data were collected using the Parenting Stress Index-Short Form (PSI-SF), Swanson, Nolan, and Pelham Version IV (SNAP-IV) Scale, and Spence Children's Anxiety Scale (SCAS). Finally, analyses were conducted using SPSS version 27 for descriptive statistics and correlations, and AMOS version 24 for SEM with bootstrapping (5,000 resamples) to test indirect effects.

Results: The components of parenting stress (parental distress, parent–child dysfunctional interaction, and difficult child characteristics) showed significant direct associations with ADHD symptom severity (p<0.001). Although direct paths from parenting stress components to child anxiety were non-significant, bootstrapping analyses confirmed a significant indirect effect: parenting stress predicted child anxiety through the mediating role of ADHD symptom severity (p<0.01).

Conclusion: These findings suggest that parenting stress is indirectly associated with higher levels of anxiety in children with ADHD through increased severity of ADHD symptoms. Clinically, targeted interventions such as parental stress management programs, parent training focused on improving parent-child interactions, and family-based support strategies are recommended to reduce parenting stress, thereby decreasing ADHD symptom severity and ultimately alleviating anxiety symptoms in this population.